Work

Septal Myectomy for Isolated Midventricular Obstruction After Alcohol Septal Ablation for Obstructive Hypertrophic Cardiomyopathy

Year: 2024

Type: article

Abstract: Background: Alcohol septal ablation is an alternative to surgical myectomy for septal reduction in obstructive hypertrophic cardiomyopathy, particularly in high-risk surgical patients. However, alcohol septal ablation can sometimes result in residual left ventricular obstruction, typically in the subaortic area and, much more rarely, in the midventricular region. Methods: This report presents 3 unique cases of isolated midventricular obstruction without systolic anterior motion that required surgical myectomy after alcohol septal ablation. Results: Three patients presented with persistent or recurrent symptoms of left ventricular outflow obstruction after alcohol septal ablation. Surgical myectomy, performed through a transapical approach alone or in combination with a transaortic approach, successfully reduced intracavitary gradients and septal thickness in all 3 patients. One patient underwent cardiac transplantation 2 years after septal myectomy due to diastolic heart failure without obstruction. Conclusions: This case series highlights concerns about the use of alcohol septal ablation for patients with long-segment subaortic obstruction and midventricular involvement, suggesting that surgical myectomy may be a more suitable treatment option for this anatomic subtype.

Source: Annals of Thoracic Surgery Short Reports

DOI: 10.1016/j.atssr.2024.10.007

Authors: Anastasiia Karadzha, Hartzell V. Schaff

Institution: Mayo Clinic

Language: English

Topic: Cardiomyopathy and Myosin Studies

Subfield: Cardiology and Cardiovascular Medicine

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $975